MORBIDLY OBESE PATIENT The Obesity Epidemic 67 are overweight or obese 117 billion spent in 2000 to treat the medical consequences of overweight and obesity 112000 deathsyear attributed to obesity ID: 585111
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PERIOPERATIVE NURSING CARE OF THE
MORBIDLY OBESE PATIENTSlide2
The Obesity Epidemic
67% are overweight or obese
$117 billion spent in 2000 to treat the medical consequences of overweight and obesity
112,000 deaths/year attributed to obesity
*
Mokdad
, A. H., Marks, J. S., Stroup, D. F., &
Gerberding
, J. L. (2004). Actual cause of death in the
United
States.
Journal of the American Medical Association, 291 (10),
1238-1245.Slide3
Health Burdon
Type 2 diabetes
Hypertension
Cardiovascular disease
Stroke
DyslipidemiasOsteoarthritisCancersSleep apneaGall bladder diseaseFemale infertilityPsychological issues
Obesity is recognized as a chronic, debilitating and potentially fatal disease. Obesity has approached smoking as a leading cause of preventable death.Slide4
SAFETY CONCERNS & SPECIAL EQUIPMENT
HIGH BMI/ BARIATRIC PATIENT HAVE RIGHT TO BE TREATED W/ COMFORT, DIGNITY, RESPECT & PRIVACY
CULTURE OF SAFETY FOR BOTH PATIENTS AND CAREGIVERS
IDENTIFY MECHANICAL LIFTING EQUIP & APPPROVED PATIENT HANDLING TECHNNIQUES.Slide5
ASSESSMENT OF HIGH BMI/ BARIATRIC PT
SENSITIVE TO PATIENT PERCEPTION-
BEDS, GURNEYS, WHEELCHAIRS THAT FIT
TALK TO THEM ABOUT WHAT TO EXPECT
ASSESS AS ALL PATIENTS PLUS:
GERD/CIRCULATION/ RESPIRATORY HIATAL HERNIA, SLEEP APNEA, ABDOMINAL GIRTH/JOINT ISSUES ANESTHESIA – WEDGE/ DIFFICULT INTUBATION CART DVT PREVENTION PHYSICAL ASSESSMENT CO-MORBIDITIES: DIABETES/ CADSlide6
ROOM PREPARATION/ POSITIONING
OR BED CAPACITY IN SPECIFIC POSITION
STANDARD (1000#)/ REVERSE (#500)
SAFETY STRAPS, GENERALLY AT LEAST TWO SETS
TRANSFER SYSTEM ALREADY ON BED
AWARE OF ANESTHESIA NEEDS US DOPPLERS GLIDE SCOPE LINE PLACEMENT WEDGE PILLOWEXTRA PILLOWS, GEL PADDING , EGGCRATESlide7
POSITIONING CONSIDERATIONS
SUPINE:
ARMBOARD –ULNA/ HYPEREXTENSION/ NEUTRAL POSITIONSAFETY STRAPS – THIGHS/ LOWER LEGS
PILLOW UNDER KNEES – NEED HEEL PROTECTION
REVERSE TRENDELENBERG- FOOTBOARD
ARMSLEDS W/ PADDING IF NEED TO TUCKFOLEY INSERTION – GET ASSISTANCE TO ACHIEVE PROPER TECHNIQUELITH: CANDY CANE – DO NOT LET LEG REST AGAINST POLE CREATIVE SIZING FOR ALLEN STIRRUPS HISTORY OF HIP INJURY/ TOTAL JOINT REPLACEMENTPRONE: LARGE GEL ROLLS/ RESPIRATORY/ PADDING/ PRESSURE POINTS ARMS MOVED CAREFULLY TO NEUTRAL POSITIONLATERAL: AXILLARY ROLL/ PADDING/ ALIGNMENT INCLUDING HEAD/NECK
PRESSURE POINTS – EAR,SHOULDER, HIP, LATERAL TO TOESSlide8
INFLATED PATIENT TRANSFER PADSlide9Slide10
ALLEN STIRRUPS
Slide11
CANDY CANE STIRRUPSSlide12
PNUEMATIC LIFT FOR LITHOTOMYSlide13Slide14
Gastric Band
Decrease in appetite, good weight loss (loss of 45% of excess weight in 2 years)
Slow but steady 2-3 pound weight loss per month
45 minute procedure, walking in hours, able to return to work in about 2 weekSlide15
Roux-en-Y
Gastric Bypass
Good satiety, good weight loss (70-80% of excess weight in the first year, sometimes even in the first 6 to 8 months
1.5 to 2 hour procedure, walking within hours of surgery, back to work in about 2 weeks
You change – tastes, activity,
etc..Slide16
Duodenal
SwitchSlide17
Gastric
SleeveSlide18
TAKE HOME
PROVIDE SUPPORTIVE & RESPECTFUL ENVIRONMENT OF CARE FOR ALL PATIENTS, REGARDLESS OF BMI!
IDENTIFY MECHANICAL LIFTING EQUIPMENT AT YOUR INSTITUTION!
GET HELP, SAVE YOUR BACK!